Part of What's Wrong With Health Care

Two patients with potential live-related donors and a jump in the creatinine to about 7. Need to get a transplant, quick, or an AV fistula for anticipated dialysis in less than 3 months. I have 2 secretaries, no nurses, no coordinators. Two different insurance companies. One patient is on a transplant list already as I've followed her for 3 years. The transplant center decides it isn't going to do any more transplants on Medicaid patients. They aren't paid enough! So they transfer the records to the other transplant center, I think!

In the last 24 hours, I've made 3-4 calls to the transplant center to get the show on the road. They've got a lot of secretaries, co-ordinators and other bodies to get the show on the road,and they've got their rituals and protocol, and it isn't going to happen, predictably, fast enough, so I have to act as though its an impossibility, and prepare for dialysis by having an AV fistula placed for anticipated dialysis.

This is not optimal, but I can't deal with other institution's inertia, or whip insurance companies into line. If he gets transplant after a fistula is placed, the surgery is an expensive and unnecessary waste.

I have to remember my role in this complex mechanism, and the limitations of what I can and can't control. I know what good medicine is. I know what patient centered medicine is. And I know what I'm up against.